Pediatric Asthma

Measuring quality of life in pediatric patients with asthma is complicated by several unique considerations. Foremost among these is the idea of parents serving as proxy respondents. Among the condition-specific instruments available, some are designed to be completed by the affected child, while others are parent-completed. It is clear that the responses of the children and parents may differ qualitatively, partly depending on the age, developmental level, and reading ability of the child¹. Age-specific questionnaires have been developed to facilitate the task of instrument completion for the child. However, parental biases may conceivably influence child-completed questionnaires, particularly if the child requires assistance with reading or interpretation of items. Concerns of parents and children may differ markedly. While parents might focus on the long range effects of asthma and asthma treatment on the child's physical, intellectual, and social development, the asthmatic child might worry most about "being different" from his peers.

When administering instruments to parents, investigators should clearly specify if one or both parents (when applicable) are to serve as respondents, as mother and father may have very different perceptions of the child's condition. A related concern is that pediatric asthma may profoundly influence the live of caregivers and other family members. Special instruments have been developed to measure the impact of pediatric asthma on parent's quality of life.

Generic Quality of Life Instruments Used in Pediatric Asthma:

Child Health and Illness Profile-Adolescent Edition (CHIP-(AE))

• Kakiuchi S, Daigo Y, Ishikawa N, et al. Prediction of sensitivity of advanced non-small cell lung cancers to gefitinib (Iressa, ZD1839). Hum Mol Genet. Dec 15 2004 ;13(24):3029-3043.
• Okelo SO, Wu AW, Krishnan JA, Rand CS, Skinner EA, Diette GB. Emotional quality-of-life and outcomes in adolescents with asthma. J Pediatr. Oct 2004;145(4):523-529.

Child Health Questionnaire - Parent Form 50

• Asmussen L, Olson LM, Grant EN, Landgraf JM, Fagan J, Weiss KB. Use of the Child Health Questionnaire in a sample of moderate and low-income inner-city children with asthma. Am J Respir Crit Care Med. 2000;162:1215-1221.
• Bukstein DA, McGrath MM, Buchnew DA, Landgraf J, Goss TF. Evaluation of a short form for measuring health-related quality of life among pediatric asthma patients. J Allergy Clin Immunol. 2000;105:245-51.
• Kanter L, Siegel C, et al Impact of respiratory symptoms on heath related quality of life and medical resource utilization of patients treated by allergy specialists and primary care providers. Ann Allergy Asthma Immunol. 2002; 89:139-147.
• Sawyer MG, Reynolds KE, Couper JJ, et al. Health-related quality of life of children and adolescents with chronic illness--a two year prospective study. Qual Life Res. 2004;13(7):1309-1319.

EuroQol (EQ-5D)

• Levy JI, Welker-Hood LK, Clougherty JE, Dodson RE, Steinbach S, Hynes HP. Lung function, asthma symptoms, and quality of life for children in public housing in Boston : a case-series analysis. Environ Health. 2004;3(1):13.

TNO-AZL Preschool Children Quality of Life Questionnaire (TAPQOL)

• Bont L, Steijn M, van Aalderen WM, Kimpen JL. “Impact of wheezing after respiratory syncytial virus infection on health-related quality of life.” Pediatr Infect Dis J. 23(5):414-7.

Functional Status II-R (FS II-R)

• Kromer ME, Prihoda TJ, Hidalgo HA, Wood PR. Assessing quality of life in Mexican-American children with asthma: impact-on-family and functional status. J Pediatr Psychol. 2000 Sep;25(6):415-26.

Condition-Specific Health-Related Quality of Life Instruments Used in Pediatric Asthma

About My Asthma

• Mishoe SC, Baker RR, Poole S, Harrell LM, Arant CB, Rupp NT. Development of an instrument to assess stress levels and quality of life in children with asthma. J Asthma 1998;35(7):553-63.

Adolescent Quality of Life Questionnaire

• Somerville A, Knopfli B, Rutishauser C. (2004) “Health-related quality of life in Swiss adolescents with asthma. Validation of the AAQOL-D and comparison with Australian adolescents.” Swiss Med Wkly. 134(7-8):91-6.

Childhood Asthma Questionnaires

• Christie MJ, French D, Sowden A, West A. Development of child-centered disease-specific questionnaires for living with asthma. Psychosom Med 1993;55(6):541-8.
• French DJ, Carroll A, Christie MJ. Health-related quality of life in Australian children with asthma: lessons for the cross-cultural use of quality of life instruments. Qual Life Res 1998;7:409-19.
• French DJ, Christie MJ, Sowden AJ. The reproducibility of the Childhood Asthma Questionnaires: measures of quality of life for children with asthma aged 4-16 years. Qual Life Res 1994;3;215-24.
• White A, Slade P, Hunt C, Hart A, Ernst E. Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. Thorax. 2003;58(4):317-21.

Children's Health Survey for Asthma

• Asmussen L, Olson LM, Grant EN, Fagan J, Weiss KB. Reliability and validity of the Children's Health Survey for Asthma. Pediatrics 1999;104(6):e71.

Functional Severity Index

• Bratton DL, Price M, Gavin L, Glenn K, Brenner M, Gelfand EW, Klinnert MD. Impact of a multidisciplinary day program on disease and healthcare costs in children and adolescents with severe asthma: a two-year follow-up study. Pediatr Pulmonol 2001;31:177-189.
• Rosier MJ, Bishop J, Nolan T, Robertson CF, Carlin JB, Phelan PD. Measurement of functional severity of asthma in children. Am J Respir Crit Care Med 1994;149:1434-41.

How Are You?

• le Coq EM, Boeke AJP, Bezemer PD, Bruil J, van Eijk JTM. Clinimetric properties of a parent report on their offspring's quality of life. J Clin Epidemiol 2000;53:139-46.
• le Coq EM, Colland VT, Boeke AJP, Bezemer DP, van EIJK JTM. Reproducibility, construct validity, and responsiveness of the "How Are You?" (HAY), a self-report quality of life questionnaire for children with asthma. J Asthma 2000;37(1):43-58.

Integrated Therapeutics Group Child Asthma Short Form

• Bukstein DA, McGrath MM, Buchnew DA, Landgraf J, Goss TF. Evaluation of a short form for measuring health-related quality of life among pediatric asthma patients. J Allergy Clin Immunol 2000;105:245-51.
• Kanter L, Siegel C, et al Impact of respiratory symptoms on heath related quality of life and medical resource utilization of patients treated by allergy specialists and primary care providers. Ann Allergy Asthma Immunol 89:139-147. 2002

KINDL

• Ravens-Sieberer U, Bullinger M. Assessing health-related quality of life in chronically ill children with the German KINDL: first psychometric and content analytical results. Qual Life Res 1998;7:399-407.

Life Activities Questionnaire for Childhood Asthma

• Creer TL, Wigal JK, Kotses H, Hatala JC, McConnaughy K, Winder JA. A life activities questionnaire for childhood asthma. J Asthma 1993;30(6):467-73.

Pediatric Asthma Caregiver's Quality of Life Questionnaire

• Bratton DL, Price M, Gavin L, Glenn K, Brenner M, Gelfand EW, Klinnert MD. Impact of a multidisciplinary day program on disease and healthcare costs in children and adolescents with severe asthma: a two-year follow-up study. Pediatr Pulmonol 2001;31:177-189.
• Dalheim-Englund AC, Rydstrom I, Rasmussen BH, Moller C, Sandman PO. (2004) “Having a child with asthma--quality of life for Swedish parents.” J Clin Nurs. 13(3):386-95.
• Erickson SR, Munzenberger PJ, Plante MJ, Kirking DM, Hurwitz ME, Vanuya RZ. Influence of sociodemographics on the health-related quality of life of pediatric patients with asthma and their caregivers. J Asthma. Apr 2002;39(2):107-117.
• Everden P, Campbell M, Harnden C, McGoldrick H, Bodalia B, Manion V, Reynia S; FACT study group. Eformoterol Turbohaler compared with salmeterol by dry powder inhaler in asthmatic children not controlled on inhaled corticosteroids. Pediatr Allergy Immunol. 2004;15(1):40-7.
• Halterman JS, Szilagyi PG, Yoos HL, Conn KM, Kaczorowski JM, Holzhauer RJ, Lauver SC , Neely TL, Callahan PM, McConnochie KM. Benefits of a school-based asthma treatment program in the absence of secondhand smoke exposure: results of a randomized clinical trial. Arch Pediatr Adolesc Med. 2004;158(5):460-7.
• Halterman JS, Yoos HL, Conn KM, et al. The impact of childhood asthma on parental quality of life. J Asthma. Sep 2004;41(6):645-653.
• Jowers JR, Schwartz AL, Tinkelman DG, Reed KE, Corsello PR, Mazzei AA, Bender DR, Lochhead RA. Disease management program improves asthma outcomes. Am J Manag Care 2000;6:585-92.
• Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Griffith LE, Townsend M. Measuring quality of life in the parents of children with asthma. Qual Life Res 1996;5(1):27-34.
• Kamps AW, Brand PL, Kimpen JL, et al. Outpatient management of childhood asthma by paediatrician or asthma nurse: randomised controlled study with one year follow up. Thorax. 2003;58(11):968-73.
• Krishna S, Francisco BD, Balas EA, Konig P, Graff GR, Madsen RW. Internet-enabled interactive multimedia asthma education program: a randomized trial. Pediatrics. 2003;111(3):503-10.
• Levy JI, Welker-Hood LK, Clougherty JE, Dodson RE, Steinbach S, Hynes HP. Lung function, asthma symptoms, and quality of life for children in public housing in Boston : a case-series analysis. Environ Health. Dec 7 2004 ;3(1):13.
• Murphy KR, Fitzpatrick S, Cruz-Rivera M, Miller CJ, Parasuraman B. Effects of budesonide inhalation suspension compared with cromolyn sodium nebulizer solution on health status and caregiver quality of life in childhood asthma. Pediatrics. 2003;112(3 Pt 1):e212-9.
• Price M, Bratton D, et al 2002 Caregiver negative affect is a primary determinant of caregiver report of pediatric asthma quality of life. Ann Allergy Asthma Immunol 89 572-577. 2002
• Reichenberg K, Broberg AG. The Paediatric Asthma Caregiver's Quality of Life Questionnaire in Swedish parents. Acta Paediatr 2001;90:45-50.
• Stevens CA, Wesseldine LJ, Couriel JM, Dyer AJ, Osman LM, Silverman M. Parental education and guided self-management of asthma and wheezing in the pre-school child: a randomised controlled trial. Thorax. Jan 2002;57(1):39-44.
• Vila G, Hayder R, Bertrand C, et al. Psychopathology and quality of life for adolescents with asthma and their parents. Psychosomatics. 2003;44(4):319-28.
• Wamboldt FS, Spahn JD, Klinnert MD, Wamboldt MZ, Gavin LA, Szefler SJ, Leung DYM. Clinical outcomes of steroid-insensitive asthma. Ann Allergy Asthma Immunol 1999;83:55-60.
• Warschburger P, von Schwerin AD, Buchholz HT, Petermann F. An educational program for parents of asthmatic preschool children: short- and medium-term effects. Patient Educ Couns. 2003;51(1):83-91.
• Williams S, Sehgal M, Falter K, et al. Effect of asthma on the quality of life among children and their caregivers in the Atlanta Empowerment Zone. J Urban Health 2000;77(2):268-79.

Pediatric Asthma Quality of Life Questionnaire

• Annett R D, Bender BG, et al. Predicting children's quality of life in an asthma clinical trial: What do children's reports tell us? J Pediatr 2001;139(6): 854-61.
• Arikan C, Bahceciler NN, Deniz G, Akdis M, Akkoc T, Akdis CA, Barlan IB. (2004) “Bacillus Calmette-Guerin-induced interleukin-12 did not additionally improve clinical and immunologic parameters in asthmatic children treated with sublingual immunotherapy.” Clin Exp Allergy. 34(3):398-405.
• Balon J, Aker PD, Crowther ER, Danielson C, Cox PG, O'Shaughnessy D, Walker C, Goldsmith CH, Duku E, Sears MR. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. N Engl J Med 1998;339(15):1013-20.
• Becker A, Swern A, Tozzi CA, Yu Q, Reiss T, Knorr B. Montelukast in asthmatic patients 6 years-14 years old with an FEV1 > 75%. Curr Med Res Opin. Oct 2004;20(10):1651-1659.
• Bratton DL, Price M, Gavin L, Glenn K, Brenner M, Gelfand EW, Klinnert MD. Impact of a multidisciplinary day program on disease and healthcare costs in children and adolescents with severe asthma: a two-year follow-up study. Pediatr Pulmonol 2001;31:177-189.
• Bueving HJ, van der Wouden JC, Raat H, et al. Influenza vaccination in asthmatic children: effects on quality of life and symptoms. Eur Respir J. Dec 2004;24(6):925-931.
• Erickson SR, Munzenberger PJ, Plante MJ, Kirking DM, Hurwitz ME, Vanuya RZ. Influence of sociodemographics on the health-related quality of life of pediatric patients with asthma and their caregivers. J Asthma. Apr 2002;39(2):107-117.
• Everden P, Campbell M, Harnden C, McGoldrick H, Bodalia B, Manion V, Reynia S; FACT study group. (2004) “Eformoterol Turbohaler compared with salmeterol by dry powder inhaler in asthmatic children not controlled on inhaled corticosteroids.” Pediatr Allergy Immunol. 15(1):40-7.
• Grootendorst DC, van den Bos J-W, Romeijn JJ, Veselic-Charvat M, Duiverman EJ, Vrijlandt EJLE, Sterk PJ, Roldaan AC. Induced sputum in adolescents with severe stable asthma. Safety and the relationship of cell counts and eosinophil cationic protein to clinical severity. Eur Respir J 1999;13:647-53.
• Guyatt GH, Juniper EF, Griffith LE, Feeny DH, Ferrie PJ. Children and adult perceptions of childhood asthma. Pediatrics 1997;99(2):165-8.
• Hesselink AE, Penninx BW, van der Windt DA, et al. Effectiveness of an education programme by a general practice assistant for asthma and COPD patients: results from a randomised controlled trial. Patient Educ Couns. Oct 2004;55(1):121-128.
• Huss K, Winkelstein M, Nanda J, Naumann PL, Sloand ED, Huss RW. Computer game for inner-city children does not improve asthma outcomes. J Pediatr Health Care. 2003;17(2):72-8.
• Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Griffith LE, Townsend M. Measuring quality of life in children with asthma. Qual Life Res 1996;5:35-46.
• Kamps AW, Brand PL, Kimpen JL, et al. Outpatient management of childhood asthma by paediatrician or asthma nurse: randomised controlled study with one year follow up. Thorax. 2003;58(11):968-73.
• Khan MS, O'Meara M, Stevermuer TL, Henry RL. Randomized controlled trial of asthma education after discharge from an emergency department. J Paediatr Child Health. Dec 2004;40(12):674-677.
• Lemaske R. Nayak, A et al. Omalizumab improves asthma related quality of life in children with allergic asthma. Pediatrics 2002 110:e55.
• Levy JI, Welker-Hood LK, Clougherty JE, Dodson RE, Steinbach S, Hynes HP. Lung function, asthma symptoms, and quality of life for children in public housing in Boston : a case-series analysis. Environ Health. 2004;3(1):13.
• Okelo SO, Wu AW, Krishnan JA, Rand CS, Skinner EA, Diette GB. Emotional quality-of-life and outcomes in adolescents with asthma. J Pediatr. 2004;145(4):523-529.
• Reichenberg K, Broberg AG. The Paediatric Asthma Caregiver's Quality of Life Questionnaire in Swedish parents. Acta Paediatr 2001;90:45-50.
• Sawyer MG, Reynolds KE, Couper JJ, et al. Health-related quality of life of children and adolescents with chronic illness--a two year prospective study. Qual Life Res. Sep 2004;13(7):1309-1319.
• Shah S, Peat JK, Mazurski EJ, Wang H, Sindhusake D, Bruce C, Henry RL, Gibson PG. Effect of peer led programme for asthma education in adolescents: cluster randomized controlled trial. BMJ. 2001;322:583-5.
• Sin DD, Bell NR, Man SF. Effects of increased primary care access on process of care and health outcomes among patients with asthma who frequent emergency departments. Am J Med. 2004;117(7):479-483.
• Vila G, Hayder R, Bertrand C, et al. Psychopathology and quality of life for adolescents with asthma and their parents. Psychosomatics. 2003;44(4):319-28.
• Vinson JA. Children with asthma: initial development of the child resilience model. Pediatr Nurs. Mar-Apr 2002;28(2):149-158.
• Wamboldt FS, Spahn JD, Klinnert MD, Wamboldt MZ, Gavin LA, Szefler SJ, Leung DYM. Clinical outcomes of steroid-insensitive asthma. Ann Allergy Asthma Immunol 1999;83:55-60.
• Wensley D, Silverman M. Peak flow monitoring for guided self-management in childhood asthma: a randomized controlled trial. Am J Respir Crit Care Med. 5 2004;170(6):606-612.
• Williams S, Sehgal M, Falter K, et al. Effect of asthma on the quality of life among children and their caregivers in the Atlanta Empowerment Zone. J Urban Health 2000;77(2):268-79.

Quality of Life in Respiratory Illness Questionnaire

• Hesselink AE, Penninx BW, Schlosser MA, Wijnhoven HA, van der Windt DA, Kriegsman DM, van Eijk JT. “The role of coping resources and coping style in quality of life of patients with asthma or COPD.” Qual Life Res. 13(2):509-18.

Battery-Type Health-Related Quality of Life Instruments Used in Pediatric Asthma

• Austin JK, Shelton MS, Risinger MW, McNelis AM. Childhood epilepsy and asthma: comparison of quality of life. Epilepsia 1994;35(3):608-15.